Pub Date : 2025-05-14DOI: 10.1016/j.sopen.2025.05.004
Ko Un Park , Mary Brindle , Heather Neuman , Tasleem J. Padamsee , Sarah Birken
In 2020, the Commission on Cancer (CoC) launched templated synoptic element documentation in operative reports (SORs) as an accreditation standard to standardize and document surgical techniques for key portions of cancer operations. The study team identified multi-level factors influencing implementation of CoC's breast cancer SORs, including variations in surgeons' knowledge about the new SOR standard. One identified facilitator of SOR dissemination was social ties. To better understand mechanisms underlying social ties in disseminating breast SORs, we performed secondary analysis of key informant interviews in this study.
Social ties were identified by characterizing the surgeon's relationship to that program's Cancer Liaison Physician (CLP) or surgeon belonging to a CoC affiliate organization (e.g., Cancer Research Program). The CLP serving as each program's designated physician quality leader was also the central actor receiving information directly from the CoC. We found that both the CLP's direct ties to the CoC, and indirect ties (e.g., personal ties to someone with direct ties to the CoC), facilitated early dissemination of information about SORs. Leveraging interorganizational ties and providing guidance to CLPs about how and when to communicate with providers about new standards may facilitate dissemination.
{"title":"Importance of social ties in dissemination of Commission on Cancer's synoptic operative report","authors":"Ko Un Park , Mary Brindle , Heather Neuman , Tasleem J. Padamsee , Sarah Birken","doi":"10.1016/j.sopen.2025.05.004","DOIUrl":"10.1016/j.sopen.2025.05.004","url":null,"abstract":"<div><div>In 2020, the Commission on Cancer (CoC) launched templated synoptic element documentation in operative reports (SORs) as an accreditation standard to standardize and document surgical techniques for key portions of cancer operations. The study team identified multi-level factors influencing implementation of CoC's breast cancer SORs, including variations in surgeons' knowledge about the new SOR standard. One identified facilitator of SOR dissemination was social ties. To better understand mechanisms underlying social ties in disseminating breast SORs, we performed secondary analysis of key informant interviews in this study.</div><div>Social ties were identified by characterizing the surgeon's relationship to that program's Cancer Liaison Physician (CLP) or surgeon belonging to a CoC affiliate organization (e.g., Cancer Research Program). The CLP serving as each program's designated physician quality leader was also the central actor receiving information directly from the CoC. We found that both the CLP's direct ties to the CoC, and indirect ties (e.g., personal ties to someone with direct ties to the CoC), facilitated early dissemination of information about SORs. Leveraging interorganizational ties and providing guidance to CLPs about how and when to communicate with providers about new standards may facilitate dissemination.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 61-63"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-10DOI: 10.1016/j.sopen.2025.04.011
Oh Jin Kwon , Esteban Aguayo , Kevin Tabibian , Jeffrey Balian , Arjun Chaturvedi , Dariush Yalzadeh , Joseph Hadaya , Yas Sanaiha , Peyman Benharash
Background
Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.
Methods
A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into non-CKD, CKD 1–2, and CKD 3–5 based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.
Results
Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as CKD 3–5. Following risk adjustment, CKD 3–5 was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to non-CKD. Additionally, both CKD 1–2 and CKD 3–5 were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, CKD 3–5 was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.
Conclusions
Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.
{"title":"National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease","authors":"Oh Jin Kwon , Esteban Aguayo , Kevin Tabibian , Jeffrey Balian , Arjun Chaturvedi , Dariush Yalzadeh , Joseph Hadaya , Yas Sanaiha , Peyman Benharash","doi":"10.1016/j.sopen.2025.04.011","DOIUrl":"10.1016/j.sopen.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into <em>non-CKD</em>, <em>CKD 1–2</em>, and <em>CKD 3–5</em> based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.</div></div><div><h3>Results</h3><div>Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as <em>CKD 3–5</em>. Following risk adjustment, <em>CKD 3–5</em> was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to <em>non-CKD</em>. Additionally, both <em>CKD 1–2</em> and <em>CKD 3–5</em> were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, <em>CKD 3–5</em> was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.</div></div><div><h3>Conclusions</h3><div>Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 87-93"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-10DOI: 10.1016/j.sopen.2025.04.012
Daniel Soroudi , Daniel S. Rouhani , Alap Patel , Ryan Sadjadi , Reta Behnam-Hanona , Nicholas C. Oleck , Israel Falade , Merisa Piper , Scott L. Hansen
Background
Artificial intelligence (AI) has significantly influenced various medical fields, including plastic surgery. Large language model (LLM) chatbots such as ChatGPT and text-to-image tools like Dall-E and GPT-4o are gaining broader adoption. This study explores the capabilities and limitations of these tools in hand surgery, focusing on their application in patient and medical education.
Methods
Utilizing Google Trends data, common search terms were identified and queried on ChatGPT-4.5 and ChatGPT-3.5 from the following categories: “Hand Anatomy”, “Hand Fracture”, “Hand Joint Injury”, “Hand Tumor”, and “Hand Dislocation”. Responses were graded on a 1–5 scale for accuracy and evaluated using the Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool (PEMAT), and DISCERN instrument. GPT 4o, DALL-E 3, and DALL-E 2 illustrated visual representations of selected ChatGPT responses in each category, which were further evaluated.
Results
ChatGPT-4.5 achieved a DISCERN overall score of 3.80 ± 0.23. Its responses averaged 91.67 ± 0.29 for PEMAT understandability and 54.67 ± 0.55 for actionability. Accuracy was 4.47 ± 0.52, with a Flesch-Kincaid Grade Level of 9.26 ± 1.04. ChatGPT-4.5 consistently outperformed ChatGPT-3.5 across all evaluation metrics. For text-to-image generation, GPT-4o produced more accurate visuals compared to DALL-E 3 and DALL-E 2.
Conclusions
This study highlights the strengths and limitations of ChatGPT-4.5 and GPT-4o in hand surgery education. While combining accurate text generation with image creation shows promise, these AI tools still need further refinement before widespread clinical adoption.
{"title":"Dall-E in hand surgery: Exploring the utility of ChatGPT image generation","authors":"Daniel Soroudi , Daniel S. Rouhani , Alap Patel , Ryan Sadjadi , Reta Behnam-Hanona , Nicholas C. Oleck , Israel Falade , Merisa Piper , Scott L. Hansen","doi":"10.1016/j.sopen.2025.04.012","DOIUrl":"10.1016/j.sopen.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has significantly influenced various medical fields, including plastic surgery. Large language model (LLM) chatbots such as ChatGPT and text-to-image tools like Dall-E and GPT-4o are gaining broader adoption. This study explores the capabilities and limitations of these tools in hand surgery, focusing on their application in patient and medical education.</div></div><div><h3>Methods</h3><div>Utilizing Google Trends data, common search terms were identified and queried on ChatGPT-4.5 and ChatGPT-3.5 from the following categories: “Hand Anatomy”, “Hand Fracture”, “Hand Joint Injury”, “Hand Tumor”, and “Hand Dislocation”. Responses were graded on a 1–5 scale for accuracy and evaluated using the Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool (PEMAT), and DISCERN instrument. GPT 4o, DALL-E 3, and DALL-E 2 illustrated visual representations of selected ChatGPT responses in each category, which were further evaluated.</div></div><div><h3>Results</h3><div>ChatGPT-4.5 achieved a DISCERN overall score of 3.80 ± 0.23. Its responses averaged 91.67 ± 0.29 for PEMAT understandability and 54.67 ± 0.55 for actionability. Accuracy was 4.47 ± 0.52, with a Flesch-Kincaid Grade Level of 9.26 ± 1.04. ChatGPT-4.5 consistently outperformed ChatGPT-3.5 across all evaluation metrics. For text-to-image generation, GPT-4o produced more accurate visuals compared to DALL-E 3 and DALL-E 2.</div></div><div><h3>Conclusions</h3><div>This study highlights the strengths and limitations of ChatGPT-4.5 and GPT-4o in hand surgery education. While combining accurate text generation with image creation shows promise, these AI tools still need further refinement before widespread clinical adoption.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 64-78"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-10DOI: 10.1016/j.sopen.2025.05.002
Ayesha P. Ng , Troy N. Coaston , Konmal Ali , Christian de Virgilio , Peyman Benharash
Background
In the absence of cholangitis, the role of intraoperative cholangiography (IOC) to exclude retained stones in mild gallstone pancreatitis (GSP) remains controversial. Using a nationally representative database, we examined the contemporary utilization of IOC and index outcomes and readmission following cholecystectomy for GSP.
Methods
All adults undergoing nonelective cholecystectomy for mild GSP in the 2017–2021 Nationwide Readmissions Database were identified. Patients were stratified based on the use of IOC. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of IOC use with outcomes of interest.
Results
Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period (p < 0.001). Compared to patients without IOC, IOC patients were older and more commonly treated at high-volume, private hospitals. Following risk adjustment, the odds of major adverse events, including mortality, complications, and bile duct injury repair were comparable between cohorts. Furthermore, length of stay and hospitalization costs were comparable between patients with and without IOC. Notably, IOC was significantly associated with 20 % decreased odds of 90-day readmission for recurrent pancreatitis or retained stone, which persisted over time (AOR 0.80 [95 % CI 0.74–0.86]).
Conclusions
IOC was associated with significantly reduced readmission and comparable resource use following cholecystectomy for GSP. Despite its decreasing utilization, IOC may be a cost-effective strategy to help reduce risk for recurrent biliary disease among patients with mild GSP.
在没有胆管炎的情况下，术中胆管造影（IOC）在轻度胆源性胰腺炎（GSP）中排除结石残留的作用仍然存在争议。使用一个具有全国代表性的数据库，我们检查了IOC的当代使用情况和指数结果以及胆囊切除术后GSP的再入院情况。方法选取2017-2021年全国再入院数据库中所有因轻度GSP接受非选择性胆囊切除术的成年人。根据IOC的使用对患者进行分层。使用多变量回归和Royston-Parmar分析来评估IOC使用与感兴趣的结果的关联。结果152,687例患者中，24.7%接受了IOC。在研究期间，IOC的利用率从26.5%显著下降到20.7% (p <；0.001)。与没有IOC的患者相比，IOC患者年龄较大，更常在大容量的私立医院接受治疗。经过风险调整后，主要不良事件（包括死亡率、并发症和胆管损伤修复）的发生率在队列之间具有可比性。此外，住院时间和住院费用在有和没有IOC的患者之间具有可比性。值得注意的是，IOC与复发性胰腺炎或结石潴留的90天再入院率降低20%显著相关（AOR 0.80 [95% CI 0.74-0.86]）。结论sioc与GSP胆囊切除术后再入院率显著降低和资源利用率相当相关。尽管其使用率下降，但IOC可能是一种具有成本效益的策略，有助于降低轻度GSP患者复发性胆道疾病的风险。
{"title":"National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis","authors":"Ayesha P. Ng , Troy N. Coaston , Konmal Ali , Christian de Virgilio , Peyman Benharash","doi":"10.1016/j.sopen.2025.05.002","DOIUrl":"10.1016/j.sopen.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>In the absence of cholangitis, the role of intraoperative cholangiography (IOC) to exclude retained stones in mild gallstone pancreatitis (GSP) remains controversial. Using a nationally representative database, we examined the contemporary utilization of IOC and index outcomes and readmission following cholecystectomy for GSP.</div></div><div><h3>Methods</h3><div>All adults undergoing nonelective cholecystectomy for mild GSP in the 2017–2021 Nationwide Readmissions Database were identified. Patients were stratified based on the use of IOC. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of IOC use with outcomes of interest.</div></div><div><h3>Results</h3><div>Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period (<em>p</em> < 0.001). Compared to patients without IOC, IOC patients were older and more commonly treated at high-volume, private hospitals. Following risk adjustment, the odds of major adverse events, including mortality, complications, and bile duct injury repair were comparable between cohorts. Furthermore, length of stay and hospitalization costs were comparable between patients with and without IOC. Notably, IOC was significantly associated with 20 % decreased odds of 90-day readmission for recurrent pancreatitis or retained stone, which persisted over time (AOR 0.80 [95 % CI 0.74–0.86]).</div></div><div><h3>Conclusions</h3><div>IOC was associated with significantly reduced readmission and comparable resource use following cholecystectomy for GSP. Despite its decreasing utilization, IOC may be a cost-effective strategy to help reduce risk for recurrent biliary disease among patients with mild GSP.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 79-86"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-30DOI: 10.1016/j.sopen.2025.04.008
Zeyu Liu BS , Saad Mallick MD , Nam Yong Cho BS , Esteban Aguayo MD , Mahima Chillakanti BS , Giselle Porter BS , Konmal Ali , Joseph Song BS , Areti Tillou MD , Peyman Benharash MD
Background
With advances in imaging and interventional techniques, traumatic injuries are increasingly managed non-operatively. However, the impact of frailty on outcomes of non-operatively managed traumatic injuries remains generally unexplored. Using a national cohort, we characterized the association of frailty with clinical and financial outcomes of non-operative trauma hospitalizations.
Methods
We identified all adult (≥18 years) hospitalizations for traumatic injuries using the 2019–2021 Nationwide Readmissions Database. Only patients who did not undergo major operations were considered. Patients were then stratified into three frailty groups based on the validated Hospital Frailty Risk Score. Multivariable models were subsequently developed to assess the association of frailty with various clinical and financial outcomes.
Results
Of an estimated 2,818,070 hospitalizations for non-operative trauma, 18.6 % were classified as low frailty (LF), 57.0 % as intermediate frailty (IF), and 24.4 % as high frailty (HF). Following risk adjustment, compared to LF, IF (Adjusted Odds Ratio [AOR] 2.4; 95 % Confidence Interval [CI], 2.0–3.0) and HF (AOR 3.3; 95 % CI, 2.7–4.1) were associated with greater odds of in-hospital mortality. Similarly, risks of major complications and non-home discharge elevated in a stepwise fashion. Furthermore, IF patients experienced an incremental increase in LOS of 1.3 days (95%CI, 1.2–1.4 days) and costs of $3200 (95 % CI, $3100–$3400) while HF patients had a prolonged LOS by 5.1 days (95 % CI, 4.8–5.2 days) and higher costs by $11,300 (95 % CI, $11,000-11,600).
Conclusion
Our findings showed frailty status to be associated with adverse clinical outcomes and increase resource utilization among hospitalizations for non-operative trauma.
{"title":"Association of frailty with clinical and financial outcomes of hospitalization for non-operative trauma","authors":"Zeyu Liu BS , Saad Mallick MD , Nam Yong Cho BS , Esteban Aguayo MD , Mahima Chillakanti BS , Giselle Porter BS , Konmal Ali , Joseph Song BS , Areti Tillou MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.04.008","DOIUrl":"10.1016/j.sopen.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>With advances in imaging and interventional techniques, traumatic injuries are increasingly managed non-operatively. However, the impact of frailty on outcomes of non-operatively managed traumatic injuries remains generally unexplored. Using a national cohort, we characterized the association of frailty with clinical and financial outcomes of non-operative trauma hospitalizations.</div></div><div><h3>Methods</h3><div>We identified all adult (≥18 years) hospitalizations for traumatic injuries using the 2019–2021 Nationwide Readmissions Database. Only patients who did not undergo major operations were considered. Patients were then stratified into three frailty groups based on the validated Hospital Frailty Risk Score. Multivariable models were subsequently developed to assess the association of frailty with various clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of an estimated 2,818,070 hospitalizations for non-operative trauma, 18.6 % were classified as low frailty (LF), 57.0 % as intermediate frailty (IF), and 24.4 % as high frailty (HF). Following risk adjustment, compared to LF, IF (Adjusted Odds Ratio [AOR] 2.4; 95 % Confidence Interval [CI], 2.0–3.0) and HF (AOR 3.3; 95 % CI, 2.7–4.1) were associated with greater odds of in-hospital mortality. Similarly, risks of major complications and non-home discharge elevated in a stepwise fashion. Furthermore, IF patients experienced an incremental increase in LOS of 1.3 days (95%CI, 1.2–1.4 days) and costs of $3200 (95 % CI, $3100–$3400) while HF patients had a prolonged LOS by 5.1 days (95 % CI, 4.8–5.2 days) and higher costs by $11,300 (95 % CI, $11,000-11,600).</div></div><div><h3>Conclusion</h3><div>Our findings showed frailty status to be associated with adverse clinical outcomes and increase resource utilization among hospitalizations for non-operative trauma.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 47-53"},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-29DOI: 10.1016/j.sopen.2025.04.010
Saad Mallick MD , Sara Sakowitz MS MPH , Syed Shahyan Bakhtiyar MD MBE , Nam Yong Cho BS , Troy Coaston BS , Esteban Aguayo MD , Peyman Benharash MD
Background
Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.
Methods
All adult hospitalizations for AAA, CABG, and COL were identified using the 2011–2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.
Results
Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (p < 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all p < 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.
Conclusions
Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.
{"title":"Race based disparities in clinical and financial outcomes associated with major elective and emergent surgery","authors":"Saad Mallick MD , Sara Sakowitz MS MPH , Syed Shahyan Bakhtiyar MD MBE , Nam Yong Cho BS , Troy Coaston BS , Esteban Aguayo MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.04.010","DOIUrl":"10.1016/j.sopen.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.</div></div><div><h3>Methods</h3><div>All adult hospitalizations for AAA, CABG, and COL were identified using the 2011–2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.</div></div><div><h3>Results</h3><div>Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (<em>p</em> < 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all <em>p</em> < 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.</div></div><div><h3>Conclusions</h3><div>Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 39-46"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-29DOI: 10.1016/j.sopen.2025.04.009
Mesut Kocaman , Stephen Johnston , Mosadoluwa Afolabi , Walter Danker , Fiona Adshead
Background
Minimizing avoidable healthcare resource use can support a move towards more sustainable healthcare systems. Few studies have sought to evaluate the environmental impact of complications associated with specific surgical procedures. The aim of this study was to assess the environmental impact associated with disruptive surgical bleeding across a broad range of procedures.
Methods
The environmental impact assessment was performed using clinical and healthcare resource use data from a retrospective database analysis of patients with disruptive bleeding across nine procedures. Emissions data from the Sustainable Healthcare Coalition were sourced for the relevant resource use activities and used to calculate the climate, water and waste impact associated with disruptive surgical bleeding.
Results
Across the procedures of interest, surgical bleeding was shown to incur a mean environmental impact of 167 kg CO2e, 267 m3 water use and 20 kg waste. Considering the incidence of disruptive bleeding per 1000 procedures, treatment of bleeding during valve procedures was associated with the highest environmental impact due to the high proportion of patients in which this complication occurs (44 %). Achieving effective and timely control of surgical bleeding events and reducing their incidence by 50 % could save up to 49 tons of CO₂e, 77,082 m3 of water use, and 6.3 tons of waste per 1000 surgical procedures.
Conclusions
Surgical bleeding is associated with a substantial environmental impact. This study demonstrates the potential to use existing resource use data associated with specific healthcare activities to assess their environmental impact, helping to identify key areas for improvement in the sustainability of surgical departments.
{"title":"Assessing the environmental impact associated with disruptive surgical bleeding","authors":"Mesut Kocaman , Stephen Johnston , Mosadoluwa Afolabi , Walter Danker , Fiona Adshead","doi":"10.1016/j.sopen.2025.04.009","DOIUrl":"10.1016/j.sopen.2025.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Minimizing avoidable healthcare resource use can support a move towards more sustainable healthcare systems. Few studies have sought to evaluate the environmental impact of complications associated with specific surgical procedures. The aim of this study was to assess the environmental impact associated with disruptive surgical bleeding across a broad range of procedures.</div></div><div><h3>Methods</h3><div>The environmental impact assessment was performed using clinical and healthcare resource use data from a retrospective database analysis of patients with disruptive bleeding across nine procedures. Emissions data from the Sustainable Healthcare Coalition were sourced for the relevant resource use activities and used to calculate the climate, water and waste impact associated with disruptive surgical bleeding.</div></div><div><h3>Results</h3><div>Across the procedures of interest, surgical bleeding was shown to incur a mean environmental impact of 167 kg CO<sub>2</sub>e, 267 m<sup>3</sup> water use and 20 kg waste. Considering the incidence of disruptive bleeding per 1000 procedures, treatment of bleeding during valve procedures was associated with the highest environmental impact due to the high proportion of patients in which this complication occurs (44 %). Achieving effective and timely control of surgical bleeding events and reducing their incidence by 50 % could save up to 49 tons of CO₂e, 77,082 m<sup>3</sup> of water use, and 6.3 tons of waste per 1000 surgical procedures.</div></div><div><h3>Conclusions</h3><div>Surgical bleeding is associated with a substantial environmental impact. This study demonstrates the potential to use existing resource use data associated with specific healthcare activities to assess their environmental impact, helping to identify key areas for improvement in the sustainability of surgical departments.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 54-60"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-23DOI: 10.1016/j.sopen.2025.04.006
Mengya Feng , Yihua Kang , Sijia Li , Dechun Yang , Shengnan Ren , Shicong Tang , Dan Mo , Hai Lei
Objective
To investigate the clinicopathological factors influencing lung and bone metastasis in breast cancer, and to further construct a nomogram model for predicting the risk of lung and bone metastasis in breast cancer patients at various time points, followed by a prognostic analysis.
Methods
The retrospective analysis included 200 patients with breast cancer, among whom 51 had lung metastases and 57 had bone metastases. The remaining 92 patients without metastases served as the control group. Baseline characteristics were analyzed using the chi-square test; COX univariate and multivariate analyses were applied to explore the influencing factors. A nomogram was constructed to predict the risk of individuals developing lung or bone metastasis at 1, 3, and 5 years. The predictive model was further validated by ROC curves and calibration curves, and decision curves were plotted to assess the clinical application value of the model.
Results
Analysis revealed that age, BMI, tumor size, lymph node status, ER, PR, HER-2, and Ki67 significantly influenced lung metastasis (P < 0.05), while age, BMI, tumor size, lymph node status, ER, PR, and Ki67 significantly impacted bone metastasis (P < 0.05). The nomogram indicated that HER-2 negativity elevated the risk of breast cancer lung metastases. ROC curves were plotted for 1, 3, and 5 years, with AUC values and 95 % confidence intervals of 0.803 (67.42-93.15), 0.831 (75.93-90.29), and 0.854 (78.43-92.34) in the lung metastasis group, and 0.754 (55.15-95.66), 0.753 (64.91-85.71), and 0.777 (68.64-86.67) in the bone metastasis group, respectively. These results suggest that the model has a superior predictive efficacy and a high degree of predictive reliability. Additionally, the calibration curve demonstrated that the model is well-fitted, and the decision curve indicated that the model possesses clinical utility in practice.
Conclusion
Age, BMI, tumor size, lymph node status, ER, PR, and Ki67 significantly influence lung and bone metastasis in breast cancer. The nomogram developed in this study can evaluate the risk of lung or bone metastasis for individuals at 1, 3, and 5 years, predict prognosis, guide clinical individualized treatment, and bring more benefits, further improving the quality of life for patients. It demonstrates good predictive ability and clinical value.
Key message
The nomogram model constructed in this study can predict prognosis, guide clinical individualized treatment, and bring more benefits, further improving the quality of life for patients. It possesses good predictive ability and holds certain clinical predictive value.
{"title":"Prognostic factors analysis and nomogram construction of breast cancer patients lung metastases and bone metastases","authors":"Mengya Feng , Yihua Kang , Sijia Li , Dechun Yang , Shengnan Ren , Shicong Tang , Dan Mo , Hai Lei","doi":"10.1016/j.sopen.2025.04.006","DOIUrl":"10.1016/j.sopen.2025.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the clinicopathological factors influencing lung and bone metastasis in breast cancer, and to further construct a nomogram model for predicting the risk of lung and bone metastasis in breast cancer patients at various time points, followed by a prognostic analysis.</div></div><div><h3>Methods</h3><div>The retrospective analysis included 200 patients with breast cancer, among whom 51 had lung metastases and 57 had bone metastases. The remaining 92 patients without metastases served as the control group. Baseline characteristics were analyzed using the chi-square test; COX univariate and multivariate analyses were applied to explore the influencing factors. A nomogram was constructed to predict the risk of individuals developing lung or bone metastasis at 1, 3, and 5 years. The predictive model was further validated by ROC curves and calibration curves, and decision curves were plotted to assess the clinical application value of the model.</div></div><div><h3>Results</h3><div>Analysis revealed that age, BMI, tumor size, lymph node status, ER, PR, HER-2, and Ki67 significantly influenced lung metastasis (P < 0.05), while age, BMI, tumor size, lymph node status, ER, PR, and Ki67 significantly impacted bone metastasis (P < 0.05). The nomogram indicated that HER-2 negativity elevated the risk of breast cancer lung metastases. ROC curves were plotted for 1, 3, and 5 years, with AUC values and 95 % confidence intervals of 0.803 (67.42-93.15), 0.831 (75.93-90.29), and 0.854 (78.43-92.34) in the lung metastasis group, and 0.754 (55.15-95.66), 0.753 (64.91-85.71), and 0.777 (68.64-86.67) in the bone metastasis group, respectively. These results suggest that the model has a superior predictive efficacy and a high degree of predictive reliability. Additionally, the calibration curve demonstrated that the model is well-fitted, and the decision curve indicated that the model possesses clinical utility in practice.</div></div><div><h3>Conclusion</h3><div>Age, BMI, tumor size, lymph node status, ER, PR, and Ki67 significantly influence lung and bone metastasis in breast cancer. The nomogram developed in this study can evaluate the risk of lung or bone metastasis for individuals at 1, 3, and 5 years, predict prognosis, guide clinical individualized treatment, and bring more benefits, further improving the quality of life for patients. It demonstrates good predictive ability and clinical value.</div></div><div><h3>Key message</h3><div>The nomogram model constructed in this study can predict prognosis, guide clinical individualized treatment, and bring more benefits, further improving the quality of life for patients. It possesses good predictive ability and holds certain clinical predictive value.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 28-38"},"PeriodicalIF":1.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-22DOI: 10.1016/j.sopen.2025.04.001
Alana Hofmann , Shimul A. Shah
{"title":"Prolonged allograft survival in liver transplantation –time to test the limits…pair with 24–00296","authors":"Alana Hofmann , Shimul A. Shah","doi":"10.1016/j.sopen.2025.04.001","DOIUrl":"10.1016/j.sopen.2025.04.001","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Page 27"},"PeriodicalIF":1.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-18DOI: 10.1016/j.sopen.2025.04.007
Danique J.I. Heuvelings , Mahdi Al-Taher , Joost Calon , Manish Chand , Laurents P.S. Stassen , Tim Lubbers , Kevin P. Wevers , Luigi Boni , Nicole D. Bouvy , Wido Heeman
Introduction
Adequate blood perfusion is widely recognized as a crucial factor for successful healing of an anastomosis and avoid anastomotic leakage. This study aimed to determine if laparoscopic laser speckle contrast imaging, can provide valuable feedback for identifying the state of tissue perfusion. Therefore, we explored the efficacy and feasibility of a new laser speckle contrast imaging system to assess real-time intestinal perfusion.
Methods
Three gradually perfused porcine small bowel loops were created, and five senior surgeons were asked to assess the perfusion differences based on laser speckle contrast images using PerfusiX-Imaging®. Subsequently, the study evaluated the impact of laser speckle contrast imaging on decision-making for anastomosis creation. Afterwards, a questionnaire was completed by all surgeons to assess the usability of the device.
Results
Results demonstrated a high accuracy (100 %) in identifying compromised perfusion and detecting perfusion differences between loops using the imaging system. In case of compromised perfusion, all surgeons recommended against creating an anastomosis based on the visual feedback. The questionnaire revealed that the senior surgeons were satisfied with the perfusion imager, particularly in terms of minimal latency, ease of use and set up, and ability to accurately represent blood flow patterns as these questions showed a (very) strong agreement in 80 %.
Conclusion
Laser speckle contrast imaging can provide valuable real-time feedback on intestinal tissue perfusion during surgery, enabling surgeons to select optimal tissue segments for a well-perfused anastomosis. However, further research is required to validate the efficacy in clinical settings and its potential impact on surgical outcomes in patients.
{"title":"Real-time intestinal perfusion assessment for anastomotic site selection using laser speckle contrast imaging: Verification in a porcine model","authors":"Danique J.I. Heuvelings , Mahdi Al-Taher , Joost Calon , Manish Chand , Laurents P.S. Stassen , Tim Lubbers , Kevin P. Wevers , Luigi Boni , Nicole D. Bouvy , Wido Heeman","doi":"10.1016/j.sopen.2025.04.007","DOIUrl":"10.1016/j.sopen.2025.04.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Adequate blood perfusion is widely recognized as a crucial factor for successful healing of an anastomosis and avoid anastomotic leakage. This study aimed to determine if laparoscopic laser speckle contrast imaging, can provide valuable feedback for identifying the state of tissue perfusion. Therefore, we explored the efficacy and feasibility of a new laser speckle contrast imaging system to assess real-time intestinal perfusion.</div></div><div><h3>Methods</h3><div>Three gradually perfused porcine small bowel loops were created, and five senior surgeons were asked to assess the perfusion differences based on laser speckle contrast images using PerfusiX-Imaging®. Subsequently, the study evaluated the impact of laser speckle contrast imaging on decision-making for anastomosis creation. Afterwards, a questionnaire was completed by all surgeons to assess the usability of the device.</div></div><div><h3>Results</h3><div>Results demonstrated a high accuracy (100 %) in identifying compromised perfusion and detecting perfusion differences between loops using the imaging system. In case of compromised perfusion, all surgeons recommended against creating an anastomosis based on the visual feedback. The questionnaire revealed that the senior surgeons were satisfied with the perfusion imager, particularly in terms of minimal latency, ease of use and set up, and ability to accurately represent blood flow patterns as these questions showed a (very) strong agreement in 80 %.</div></div><div><h3>Conclusion</h3><div>Laser speckle contrast imaging can provide valuable real-time feedback on intestinal tissue perfusion during surgery, enabling surgeons to select optimal tissue segments for a well-perfused anastomosis. However, further research is required to validate the efficacy in clinical settings and its potential impact on surgical outcomes in patients.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 12-17"},"PeriodicalIF":1.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号